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General NPI Number Information
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NPI Number | 1245107580
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Entity Type | Organization
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Legal Business Name | PRIMUS MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 10817 S JOG RD STE 230
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-0912
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Country | US
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Telephone | 561-634-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 W WOOLBRIGHT RD STE 317
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6364
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | RICHARD LUCIBELLA
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Credential |
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Telephone | 561-634-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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